Research on the mechanism and management of atrial fibrillation after MIDCAB, OPCAB surgery

房颤是冠状动脉搭桥术后常见的并发症，但微创和非体外循环冠状动脉搭桥术后房颤的发生情况知之甚少。为确定冠状动脉搭桥术后房颤的预测因素，对138例微创冠状动脉搭桥术和129例非体外循环冠状动脉搭桥术后房颤的发生进行多因素分析。术前合并糖尿病(CR4.844，95%CI 2.356~9.958，P=0.000)、术前肾功能衰竭(CR2.845，95%CI 1.176~6.884，P=0.002)和右冠状动脉搭桥术(CR 3.540，95%CI 1.020~12.279，P=0.046)。低左室射血分数和术前钙拮抗剂入院倾向较高。2)在冠状动脉不停跳手术中进行电生理标测。然而，AF并没有被开发出来，也没有得到有关AF的数据。窦性心律时，心房、上腔静脉和肺静脉均未见异常电位。研制了一种新的房颤心外膜标测计算机分析系统。使用快速傅立叶变换的频谱分析对于检查AF周期长度是有用的。3)为了阐明自发房颤的发生机制，对动态心电图进行了快速傅立叶变换分析。频谱分析表明，房颤的自发终止可能依赖于纤颤波的解离，药物诱导的终止可能依赖于房颤的组织。

Atrial fibrillation (af) is frequent complication after coronary artery bypass surgery, but little was known after minimally invasive coronary artery bypass (MIDCAB) and off-pump coronary artery bypass (OPCAB).To determine the predictor of af after beating coronary artery bypass, multianalysis was performed using SPSS in MIDCAB (N=138) and OPCAB (N=129) patients. Postoperative af developed in 59 patients(22.1%).Multivariate predictors were preoperative combination of diabetes mellitus (CR4.844, 95%CI 2.356-9.958, p=0.000), preoperative renal failure (CR2.845, 95%CI 1.176-6.884, p=0.002) and bypass graft for right coronary artery (CR 3.540, 95%CI 1.020-12.279, p=0.046). High tendency was seen in low LV ejection fraction and preoperative Ca antagonist admission. 2) Electrophysiological mapping study was performed during beating coronary artery surgery. However af was not developed and no data of af was obtained. During sinus rhythm abnormal potential was absent on atrium, SVC and pulmonary veins. New computer analyzing system of epicardial mapping for af was developed. Spectral analysis using a fast Fourier transforms was useful to check af cycle length. 3) To clarify the mechanism of spontaneous af, fast Fourier transform analysis of Holter EGG was used. Spectral analysis showed that spontaneous termination of af may depend on the disorganization of fibrillation waves and drug-induced termination may depend on the organization of af.